F.G. Zitman

Psychomotor slowing and planning deficits in schizophrenia

The relative contribution of cognitive and motor processing to psychomotor slowing in schizophrenia was investigated using three tasks: a simple line-copying task and a more complex figure-copying task, both following a reaction paradigm, and a standard psychomotor test, the Digit Symbol Test (DST). Various movement variables of the task performances were derived from recordings made with the aid of a digitizing tablet. The patients with schizophrenia appeared to be about one-third slower in their total performance time on all three tasks when compared with healthy controls, which suggests a general psychomotor slowing in this group. When itemized over the various movement variables, this slowing was found in both initiation time and movement time in the copying tasks and in the DST in the time to match the symbol and the digit, but not in writing the digit. Furthermore, in the figure-copying task it was found that increased figure complexity or decreased familiarity prolonged the initiation time. These latency increases were not significantly larger for the schizophrenia group as a whole, but only for a subgroup of patients with higher scores on negative symptoms. Regarding reinspection time, the effects of familiarity were larger in the schizophrenia group as a whole. These group findings suggest that patients tend to plan their actions less in advance, which, in the case of the more complex or unfamiliar task conditions, is a less sophisticated planning strategy. Given the longer latencies in patients with more severe negative symptoms, it seems that these patients have problems with turning a plan into action. The present study provides evidence of psychomotor slowing and planning deficits in schizophrenia.

Fine motor retardation and depression

New computerized techniques allow the precise measurement of psychomotor retardation in patients with a major depressive episode (MDE). One such technique is the analysis of writing and drawing behaviour during figure copying tasks. In the present study, 22 inpatients with an MDE were compared to 22 normal controls. Three tasks were used: the drawing of lines and simple figures, the copying of complex figures and a task in which figures had to be rotated. Objectives were to provide support for earlier findings that the patients were slower than the controls and to explore the cognitive and motor processes involved. Two strategies were applied: analysis of the reaction time and movement time and their different components, and manipulation of the cognitive and motor demands. Patients showed considerable retardation with most of the kinematic variables. Motor deficits and cognitive slowing down contributed to this retardation. Cognitive difficulties increased with increasing complexity of the task.

High prevalence of benzodiazepine dependence in out-patient users, based on the DSM-III-R and ICD-10 criteria

Despite the fact that there have been many reports on benzodiazepine (BZD) dependence, consensus about its definition has not been reached. Reliable prevalence data to estimate the dependence liability of BZDs are therefore lacking. This study is the first to assess the prevalence of BZD dependence in out‐patient BZD users (115 general practice (GP) patients, 124 psychiatric out‐patients and 33 self‐help patients) on the basis of the DSM‐III‐R and ICD‐10 substance dependence criteria. Past year and lifetime diagnoses of BZD dependence were made by means of the Schedules for Clinical Assessments in Neuropsychiatry (SCAN). High prevalence figures were found, ranging from 40% in the GP patients (DSM‐III‐R past year) to 97% in the self‐help patients (ICD‐10 lifetime), indicating that BZD users run a high risk of developing BZD dependence. The clinical management of BZD use could benefit from further development of diagnostic instruments such as a self‐report questionnaire which reflects the severity of BZD dependence.

Retardation in depression: assessment by means of simple motor tasks

BACKGROUND Psychomotor retardation in depression has mostly been assessed with tasks requiring both cognitive and motor processes. This study tested whether retardation could be measured if the cognitive demands of the task were minimal. METHODS 30 inpatients with a major depressive episode were compared one week after the start of antidepressant treatment, to 30 healthy control persons, matched for age, sex and educational level. Tests consisted of ten simple drawing tasks. The kinematics of drawing movements were recorded using a specially designed pen, a graphics tablet and a personal computer. RESULTS Patients showed marked motor slowing on all the tasks: longer movement durations, longer pauses and lower velocities. CONCLUSIONS Psychomotor retardation in depressed patients treated with antidepressants occurs during drawing tasks, in which the cognitive demands are minimal and less than those required in the figure copying tasks used in our previous studies. LIMITATIONS The use of co-medication can have influenced the results, although no correlations were found between the use of medication and the kinematic variables. CLINICAL RELEVANCE Detailed registration and analysis of drawing movements enable a more precise diagnosis of psychomotor disturbances in depressed patients.

Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups

&NA; The aims of this study were to(a) investigate the efficacy of autogenic training (AT) and cognitive self‐hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting‐list control (WLC) condition,(b) investigate the influence of subject recruitment on treatment outcome(c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post‐treatment and follow‐up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL‐90) scores and medication use. Follow‐up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high‐hypnotizable subjects achieved a greater reduction in headache pain at post‐treatment and follow‐up than did the low‐hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.

Differentiation of cognitive and motor slowing in the Digit Symbol Test (DST): differences between depression and schizophrenia

Abstract Schizophrenia and depression have an overlap in symptomatology, namely a slowing in both motor and mental activities, denoted in depression as ‘psychomotor retardation’ and in schizophrenia as ‘psychomotor poverty’. By means of a new technique that allows the measurement of psychomotor speed and the computerized analysis of writing movements recorded during the performance of the Digit Symbol Test, it indeed proved to be possible to observe a slowing in both disorders. In addition, a different structure of slowing in the two patient groups could be identified.

Changes in fine motor retardation in depressed patients treated with fluoxetine.

Changes in psychomotor slowing were studied in 21 inpatients with a Major Depressive Episode. Fine motor retardation was measured and analysed using computer-aided drawing and figure-copying tasks at T0 (the start of 6 weeks treatment with fluoxetine 20 mg/day) and 5 weeks later (T1). The differences in reaction time between the patients and a group of healthy, matched controls at T0 had disappeared at T1. The initial motor deficit, expressed in longer movement times, had not improved at T1. These findings combined with the effect of manipulation of cognitive and motor demands, suggested that only cognitive processes had accelerated.

Predictors of long-term benzodiazepine abstinence in participants of a randomized controlled benzodiazepine withdrawal program

Objective: To identify predictors of resumed benzodiazepine use after participation in a benzodiazepine discontinuation trial. Method: We performed multiple Cox regression analyses to predict the long-term outcome of a 3-condition, randomized, controlled benzodiazepine discontinuation trial in general practice. Results: Of 180 patients, we completed follow-up for 170 (94%). Of these, 50 (29%) achieved long-term success, defined as no use of benzodiazepines during follow-up. Independent predictors of success were as follows: offering a taper-off program with group therapy (hazard ratio [HR] 2.4; 95% confidence interval [CI], 1.5 to 3.9) or without group therapy (HR 2.9; 95%CI, 1.8 to 4.8); a lower daily benzodiazepine dosage at the start of tapering off (HR 1.5; 95%CI, 1.2 to 1.9); a substantial dosage reduction by patients themselves just before the start of tapering off (HR 2.1; 95%CI, 1.4 to 3.3); less severe benzodiazepine dependence, as measured by the Benzodiazepine Dependence Self-Report Questionnaire Lack of Compliance subscale (HR 2.4; 95%CI, 1.1 to 5.2); and no use of alcohol (HR 1.7; 95%CI, 1.2 to 2.5). Patients who used over 10 mg of diazepam equivalent, who had a score of 3 or more on the Lack of Compliance subscale, or who drank more than 2 units of alcohol daily failed to achieve long-term abstinence. Conclusions: Benzodiazepine dependence severity affects long-term taper outcome independent of treatment modality, benzodiazepine dosage, psychopathology, and personality characteristics. An identifiable subgroup needs referral to specialized care.

Autogenic training and self-hypnosis in the control of tension headache

This study compares autogenic training and training in multiple self-hypnosis strategies in a sample of 56 patients diagnosed as having chronic tension headache on the basis of medical evaluation by a neurologist. At posttreatment and follow-up, no differences between the two treatment regimens in the reduction of headache and psychological distress were observed. During treatment, patients reduced their headache activity and level of psychological distress significantly in contrast to the waiting-list period (p < 0.05). Follow-up measurements indicated that therapeutic improvement was maintained (p < 0.05). Short-term and long-term pain reduction was accompanied by an increase in perceived pain control (p < 0.003). Moreover, those patients who attributed the pain reduction obtained during therapy to their own efforts manifested long-term pain reduction (p < 0.003).

Depressive retardation and treatment with fluoxetine: Assessment of the motor component

Changes in motor slowing between the start and end of treatment were studied in 22 inpatients with a Major Depressive Episode and 22 normal, healthy control persons. The degree and pattern of motor slowing were measured and analysed using computer-aided simple drawing tasks that did not require any higher order cognitive processing. The patients were treated with fluoxetine 20 mg/day for 6 weeks. Tests took place after 1 week (T0) and 6 weeks (T1). At T0 patients showed marked slowing, apparent in longer movement times and lower velocities than their controls. The differences between groups increased as the size of the movement increased or the accuracy demands increased. In all the trials, patients showed clear initiation difficulties. At T1 the motor slowing of the depressed patients had improved, but not disappeared. Significant differences remained between the two groups.